Orthopedic Plate with Modular Peg and Compression Screw

ABSTRACT

Assemblies and methods for fixation of bone or bone fragments using an orthopedic plate, a modular peg, and a compression screw. The modular peg is screwed into one of the apertures of the orthopedic plate. The modular peg may include an aperture having screw threads designed to receive the threads of the compression screw and serve as an anchor for the compression screw. By rotating the compression screw in relation to the modular peg, the compression screw may advance through the aperture of the modular peg, drawing the head of the screw toward the modular peg, and compressing the bone or bone fragments.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation of U.S. patent application Ser. No.17/027,724, filed on Sep. 22, 2020, which is a continuation of U.S.patent application Ser. No. 15/947,661, filed on Apr. 6, 2018, whichclaims the benefit of Provisional Application No. 62/482,552, filed Apr.6, 2017, and Provisional Application No. 62/649,330, filed Mar. 28,2018, the entire contents of those applications are herein incorporatedby reference.

FIELD OF THE INVENTION

This invention relates to the field of implant devices for bonefixation, and more particularly, to the combination of an orthopedicplate with a compression screw, using a modular peg as an anchor for thecompression screw.

BACKGROUND OF THE INVENTION

Orthopedic plates are used to join two bones or bone fragments together,for example two adjoining phalangeal bones of the foot. Orthopedicplates typically have a plurality of apertures for receiving one or morescrews or posts. The leading ends of the screws or posts may be insertedthrough one or more of the apertures and implanted into one of the bonesor bone fragments. The plates and screws maintain the position andorientation of the bones or bone fragments and provide stabilization.One or more screws may be inserted into each bone. FIG. 1 shows anexample of an orthopedic plate with a plurality of screws.

It may also be desirable to impart compression to the bone or bonefragments. Compression may be achieved by, for example, using one ormore screws to join the bones or bone fragments. FIG. 2 discloses anexample of screws used to compress two bones together. Assemblies ofscrews used to compress bones are also disclosed in prior patents suchas U.S. Pat. Nos. 9,017,329 and 9,044,282, incorporated herein byreference.

In certain circumstances, it may be desirable to implant an orthopedicplate and also implant one or more compression screws. However, thescrews used to attach the orthopedic plate to bones or bone fragmentsmay, when implanted, occupy a portion or portions of the bones or bonefragments through which it may be preferable to implant the compressionscrews, thereby preventing the compression screws from being implantedat certain positions and/or angles. In addition, with certain prior artassemblies or apparatuses, it may be difficult to determine prior toimplantation of a compression screw the extent to which a desiredimplant path for the screw will be blocked by one or more of the screwsused to attach the plate.

A staple may also be used to compress two bones or bone fragments.However, commercially available orthopedic plates typically cover thejoint between the two bones or bone fragments thereby reducing theexposed bone area into which the arms of a staple may be inserted.

Certain bone plates capable of providing compression in addition tostabilization have been developed. For example, U.S. Pat. No. 9,005,255discloses an orthopedic plate with a compression housing that receives acompression screw. However, the angle at which the compression screw maybe implanted is limited to a specific angle determined by the shape ofthe compression housing. Also, U.S. Pat. Nos. 8,574,270 and 8,974,504disclose bone plates having multiple segments, and springs that providea contractive force to compress the segments together. However, theconstruction of such multi-segment bone plates is complex and expensive,and the amount of compressive force they may generate is limited to thetensile force of the springs.

SUMMARY OF THE INVENTION

The present invention is directed to assemblies and methods for fixationof bones or bone fragments. The invention provides a novel way ofcombining the stabilization afforded by an orthopedic plate with thecompressive force generated by a compression screw. A modular peg isinserted through one of the apertures of the orthopedic plate. Themodular peg may include an aperture having screw threads designed toreceive the threads of a compression screw. The modular peg may serve asan anchor for the compression screw. By rotating the compression screwin relation to the modular peg, the compression screw may advancethrough the aperture of the modular peg, drawing the head of the screwtoward the modular peg, and thereby compressing the bone or bonefragments.

A modular peg in accordance with the present invention, without anorthopedic plate, may serve as an anchor for a compression screw. Themodular peg may include an aperture having screw threads designed toreceive the threads of a compression screw. Screw threads on the outersurface of the modular peg may facilitate implantation of the modularpeg into bone and/or securing the modular peg to bone. As describedabove for the assembly including an orthopedic plate, by rotating thecompression screw in relation to the modular peg, the compression screwmay advance through the aperture of the modular peg, drawing the head ofthe screw toward the modular peg, and thereby compressing the bone orbone fragments.

Another object of the present invention is to provide a targeting guidefor implanting a compression screw. The targeting guide may include akey insert designed to fit into an indentation of the modular peg.Inserting the key insert of the targeting guide into the indentation ofthe modular peg may ensure that the screw guide of the targeting guideis aligned with the aperture of the modular peg. The targeting guide maybe rotated about the center axis of the modular peg, allowing thecompression screw to be implanted at various angles in relation to theorthopedic plate and the joint between the bone or bone fragments to becompressed.

Another object of the present invention is to provide an orthopedicplate having a slot or cutout that allows a staple to be insertedtherethrough. Each end of the staple may be inserted into one of thebone or bone fragments to be fixated. The staple may provide acompressive force to the bone or bone fragments. The staple may be usedwith or instead of the modular peg and compression screw describedabove.

BRIEF DESCRIPTION OF THE DRAWINGS

A further understanding of the invention can be obtained by reference toembodiments set forth in the illustrations of the accompanying drawings.Although the illustrated embodiments are merely exemplary of systems,methods, and apparatuses for carrying out the invention, both theorganization and method of operation of the invention, in general,together with further objectives and advantages thereof, may be moreeasily understood by reference to the drawings and the followingdescription. Like reference numbers generally refer to like features(e.g., functionally similar and/or structurally similar elements).

The drawings are not necessarily depicted to scale; in some instances,various aspects of the subject matter disclosed herein may be shownexaggerated or enlarged in the drawings to facilitate an understandingof different features. Also, the drawings are not intended to limit thescope of this invention, which is set forth with particularity in theclaims as appended hereto or as subsequently amended, but merely toclarify and exemplify the invention.

FIG. 1 depicts an example of existing bone plate and bone screws;

FIG. 2 depicts an example of existing compression screws;

FIG. 3 depicts an orthopedic plate and modular peg in accordance with anembodiment of the present invention;

FIGS. 4A-4C depict modular pegs in accordance with an embodiment of thepresent invention;

FIG. 5 depicts an assembly of an orthopedic plate, a modular peg, and acompression screw in accordance with an embodiment of the presentinvention;

FIG. 6 depicts a compression screw;

FIGS. 7A-7C depict alternate plate and screw configurations inaccordance with the present invention;

FIG. 8A depicts a compression screw targeting guide in accordance withan embodiment of the present invention;

FIG. 8B depicts a compression screw targeting guide and a modular peg inaccordance with an embodiment of the present invention;

FIGS. 9A and 9B depict cut away views of a key insert of a compressionscrew targeting guide inserted in a modular peg in accordance with anembodiment of the present invention;

FIG. 10A depicts an assembly of an orthopedic plate, a modular peg, anda compression screw with a compression screw targeting guide inaccordance with an embodiment of the present invention;

FIG. 10B depicts an assembly of an orthopedic plate, a modular peg, anda targeting guide in accordance with an embodiment of the presentinvention;

FIG. 11 depicts a method of implantation in accordance with the presentinvention;

FIGS. 12A and 12B depict side and top views, respectively, of anassembly of a modular peg and a compression screw in accordance with thepresent invention;

FIG. 13 depicts an assembly used to repair an avulsion fracture, inaccordance with the present invention;

FIG. 14 depicts a top view of an orthopedic plate, bone screws, and astaple in accordance with an embodiment of the present invention;

FIG. 15 depicts a perspective view of the orthopedic plate, bone screws,and staple depicted in FIG. 14 ;

FIG. 16 depicts a side view of the orthopedic plate, bone screws, andstaple depicted in FIG. 14 ;

FIG. 17 depicts a top view of an orthopedic plate, bone screws, acompression screw, and a staple in accordance with an embodiment of thepresent invention.

DETAILED DESCRIPTION OF THE INVENTION

The invention may be understood more readily by reference to thefollowing detailed descriptions of embodiments of the invention.However, techniques, systems, and operating structures in accordancewith the invention may be embodied in a wide variety of forms and modes,some of which may be quite different from those in the disclosedembodiments. Also, the features and elements disclosed herein may becombined to form various combinations without exclusivity, unlessexpressly stated otherwise. Consequently, the specific structural andfunctional details disclosed herein are merely representative. Yet, inthat regard, they are deemed to afford the best embodiment for purposesof disclosure and to provide a basis for the claims herein, which definethe scope of the invention. It must be noted that, as used in thespecification and the appended claims, the singular forms “a”, “an”, and“the” include plural referents unless the context clearly indicatesotherwise.

As shown in FIG. 3 , orthopedic plate (30) may be implanted across thesite where two or more bone or bone fragments (22, 24) meet. Orthopedicplate (30) has a bottom surface (34, not shown) that may make contactwith one or more the bones or bone fragments, and a top surface (32).Top surface (32) of orthopedic plate (30) may have one or more apertures(40, 42, 44), each aperture (40, 42, 44) leading to a bore that extendsfrom the aperture (40, 42, 44) to a corresponding aperture on the bottomsurface (34). The center line of each bore may be perpendicular to topsurface (32) and/or bottom surface (34). In the alternative, the centerline of each bore may be set at an angle other than perpendicular to topsurface (32) and/or bottom surface (34), for example, 5 degrees, 10degrees, 15 degrees, 20 degrees, 25 degrees, 30 degrees, 35 degrees, 40degrees, 45 degrees, or any other angle from perpendicular to topsurface (32).

One or more apertures (42) may be situated over a first bone or bonefragment (22), and one or more apertures (44) may be situated over asecond bone or bone fragment (24). Each aperture (40, 42, 44) may becircular or may be another shape, such as an oval, an elongated circle,or a rectangle having semi-circular ends. One or more apertures (40, 42,44) at top surface (32), one or more of the apertures at bottom surface(34), and/or one or more bores may be tapered. In addition or in thealternative, one or more of the bores may be threaded.

The apertures of orthopedic plate (30) may be arranged in one or moreclusters, which may be dictated by the shape of orthopedic plate (30)and/or the bones or bone fragments to be joined. Orthopedic plate (30)may have any shape, and top surface (32) and/or bottom surface (34) oforthopedic plate (30) may be curved or otherwise shaped to follow thecontour of one or more of the bone or bone fragments that it is used tojoin. For example, as shown in FIG. 3 , orthopedic plate (30) may havean elongated shape with a first plurality of apertures (42) arranged ata first end (31) of orthopedic plate (30) and a second plurality ofapertures (44) arranged at a second end (33) of orthopedic plate (30).The distance between the closest point of each aperture in a cluster maybe no more that the radius of the smallest aperture, or the diameter ofthe smallest aperture. The distance between the clusters as measuredbetween the closest apertures (40) may be greater than a multiple of thediameter of one of the apertures (40).

Orthopedic plate (30) may be attached to first bone or bone fragment(22) and/or second bone or bone fragment (24) by one or more bone screws(50). Each bone screw (50) may be inserted through an aperture (40) andthe corresponding bore in orthopedic plate (30) and implanted into abone or bone fragment (22, 24) by, for example, rotating bone screw (50)so that the threads of bone screw (50) cause bone screw (50) to bescrewed into bone or bone fragment (22, 24). The size and/or shape ofeach aperture (40) may be the same or substantially the same as the sizeand/or shape of the head or shaft of bone screw (50) to be insertedtherein. The head of each bone screw may be tapered, bulbous,semispherical, cylindrical, or any other shape. The exterior surface ofthe screw head may be threaded. When each bone screw (50) is implantedinto bone or bone fragment, the exterior surface of the head of bonescrew (50) may abut the interior surface of the bore at aperture (40).Each bone screw (50) may thereby couple to orthopedic plate (30). In thealternative or in addition, the bore into which one or more of the bonescrews (50) is inserted may have a threaded interior surface, and theexterior surface of the head of one or more bone screws (50) may bethreaded. The threads on the exterior surface of the head of each bonescrew may engage the threads on the interior surface of each bore.

In the alternative or in addition, one or more apertures (46, 48) may beelongated in a direction parallel to and/or in line with thelongitudinal axis of the orthopedic plate. Longitudinal axis (75) oforthopedic plate (30) shown in FIG. 3 extends from the first end (31) tothe second end (33). In addition or in the alternative, one or moreapertures (not shown) may be elongated in a direction that is offset atan angle from longitudinal axis (75) of orthopedic plate (30). The anglemay be, for example, less than degrees offset from longitudinal axis(75). The shape of apertures (46, 48) in FIG. 3 is that of an elongatedcircle.

A bone screw (50) inserted through an elongated aperture and implantedinto bone or bone fragment (22, 24) may move in relation to orthopedicplate, for example along the longitudinal axis of the elongatedaperture, as the bone or bone fragment (22, 24) in which the bone screwis implanted is compressed with another bone or bone fragment (22, 24).

FIGS. 7A-7C depict other example embodiments of orthopedic plates andscrew configurations in accordance with the present invention. FIG. 7Adepicts an orthopedic plate (700) having three apertures (712, 714, 716)at a first end and two apertures (718, 720) at a second end. Aperture(716) is elongated along the longitudinal axis of orthopedic plate (700)and is tapered at the right side of the aperture. As depicted in FIG.7A, a modular peg (725) is inserted in aperture (714) and compressionscrew (730) is engaged with modular peg (725).

FIG. 7B depicts an orthopedic plate (740) having two apertures (752,754) at a first end and two apertures (756, 758) at a second end.Apertures (756, 758) are both aligned with the longitudinal axis oforthopedic plate (740). Orthopedic plate (740) is also curved to followthe contour of one or more of the bones for which it is used to join.Each aperture may receive a bone screw or a modular peg. As depicted inFIG. 7B, a modular peg (755) is inserted in aperture (752) andcompression screw (760) is engaged with modular peg (755).

FIG. 7C depicts orthopedic plate (760) having a U-shape with a first arm(762) and second arm (764), joined by a bridge section (766). First arm(762) and second arm (764) each have a plurality of apertures that eachmay receive a bone screw or a modular peg. As depicted in FIG. 7C, amodular peg (770) is inserted in one of the apertures in first arm (762)and compression screw (775) is engaged with modular peg (755).

Orthopedic plate (30) may be used to join a proximal bone (22) and adistal bone (24) of the foot. Orthopedic plate (30) may be implanted byfirst placing orthopedic plate (30) over the site where proximal bone(22) and distal bone (24) are to be joined. A bone screw (50) may firstbe implanted in proximal bone (22) by inserting the bone screw (50)through an aperture (42) in the top surface (32) of orthopedic plate(30), through the corresponding bore leading to bottom surface (34) oforthopedic plate (30), and then screwing bone screw (50) into proximalbone (22). One or more additional bone screws (50) may then be implantedin proximal bone (22). After one or more bone screws (50) are implantedin proximal bone (22) thereby attaching orthopedic plate to proximalbone (22), a bone screw (50) may be implanted in distal bone (24) byinserting the bone screw (50) through an aperture (40) in the topsurface (32) of orthopedic plate (30), through the corresponding boreleading to bottom surface (34) of orthopedic plate (30), and thenscrewing bone screw (50) into distal bone (24).

In the alternative, a bone screw (50) may first be implanted in distalbone (24) by inserting the bone screw (50) through an aperture (40) inthe top surface (32) of orthopedic plate (30), through the correspondingbore leading to bottom surface (34) of orthopedic plate (30), and thenscrewing bone screw (50) into distal bone (24). One or more additionalbone screws (50) may then be implanted in distal bone (24). After one ormore bone screws (50) are implanted in distal bone (24) therebyattaching orthopedic plate to distal bone (24), a bone screw (50) may beimplanted in proximal bone (22) by inserting the bone screw (50) throughan aperture (42) in the top surface (32) of orthopedic plate (30),through the corresponding bore leading to bottom surface (34) oforthopedic plate (30), and then screwing bone screw (50) into proximalbone (22).

While one or more of the bone screws (50) are being implanted, theorthopedic plate may be provisionally pinned in place with pins. Eachpin may be inserted through an aperture and into a bone or bone fragment(22, 24). A hole may first be drilled for each pin before the pin isinserted. A pin may be used to join the orthopedic plate to proximalbone (22) and/or a pin may be used to join the orthopedic plate todistal bone (24). When at least one bone screw (50) is implanted intoproximal bone (22), a pin used to join the orthopedic plate to proximalbone (22) may be removed. When at least one bone screw (50) is implantedinto distal bone (24), a pin used to join the orthopedic plate to distalbone (24) may be removed.

Each bone screw (50) may comprise a shaft extending from a first end toa second end along an axis. The first end may have a head (52). Head(52) may be tapered, bulbous or another shape. The outer surface of head(52) may have threads capable of mating with screw threads in aperture(40) of orthopedic plate (30). The second end of bone screw (50) may bethreaded. The leading edge of bone screw (50) may comprise self-tappingthreads.

As shown in FIG. 3 , a peg may be inserted through an aperture (40) inorthopedic plate (30), through the corresponding bore, and into one ofthe bones or bone fragments (22, 24). Exemplary peg (80) is shown inFIG. 3 . Threads on the exterior surface of the peg (80) may engagethreads on the interior surface of the bore. In the alternative, peg(80) may first be implanted into bone or bone fragment (22, 24) byscrewing peg (80) into the bone or bone fragment (22, 24) and/or byfirst drilling a hole in bone or bone fragment (22, 24). Orthopedicplate (30) may then be placed over the bones or bone fragments (22, 24)with peg (80) beneath bottom surface (34) of orthopedic plate (30) atthe time that orthopedic plate (30) is placed. Peg (80) may then berotated such that threads on the outer surface of peg (80) engagethreads in a bore in orthopedic plate (30) and the upper portion of peg(80) is inserted through the bore from beneath orthopedic plate (30).

In the alternative, a peg may be attached to orthopedic plate (30) byother means, including by press fitting or by snapping. In thealternative, a separate component, such as a cap (not shown), may beused to attached the top end of peg (80) to orthopedic plate (30).

A plurality of pegs may be coupled to orthopedic plate (30), each peginserted through one of the apertures (40) in orthopedic plate (30). Forexample, a plurality of pegs may be inserted through apertures (40) inorthopedic plate (30) and into one of the bones or bone fragments (22,24). In another embodiment, at least one peg (80) may be insertedthrough an aperture (40) in orthopedic plate (30) and into proximal bone(22), and at least one peg (80) may be inserted through an aperture (40)in orthopedic plate (30) and into distal bone (24).

In each embodiment disclosed herein, when a peg (80) is implanted to itsfinal position, no portion of peg (80) extends above top surface (32) oforthopedic plate (30).

Each peg may extend from a top end to a bottom end, with a longitudinalaxis extending from the center of the top end to the center of thebottom end. The peg may be one solid form, or may be comprised of twoportions joined together as shown, for example, by modular peg (80) inFIGS. 4A-4C. The peg may be cylindrical, may have a squarecross-section, a rectangular cross-section, an oval cross-section, atriangular cross-section, or any other shaped cross-section. The peg mayalso have multiple cross sections between the top portion and the bottomportion of the peg. If the peg has a top portion and a bottom portion,the portions may have the same cross-section, or may have differentcross-sections—different shapes, different sizes, or both. The peg mayalso be tapered so as to be wider at the top end than the bottom end, orso as to be wider at the bottom end than the top end. The peg may alsohave one or more cutouts along the outer surface of the peg. The cutoutsmay serve to reduce the weight of the peg, or to allow for bone to growtherein to secure the peg to a bone or bone fragment (22, 24).

Each peg may have one or more apertures. A bore may extend transverselyfrom each aperture partially or completely through the peg. Each boremay be fully threaded, may have no threads, or may be threaded for aportion of the length of the bore and have no threads for the remainderof the length of the bore. The center axis of each bore may intersectthe longitudinal axis of the peg at a perpendicular angle or at an angleoffset from a perpendicular angle.

If the peg includes a plurality of bores, each bore may have the samediameter, or the bores may have different diameters. If a peg has morethan one bore, the center axis of each bore may be parallel with eachother, or may be offset at one or more angles.

The top end of each peg may include a first set of screw threads on theouter surface capable of mating with screw threads on the inner surfaceof a bore of orthopedic plate (30). The outer surface of the bottom endof each peg may have screw threads capable of engaging the bone or bonefragment (22, 24). The screw threads at the bottom end of each peg maybe self-tapping threads. The bottom end of each peg may be tapered tofurther facilitate screwing the peg into bone fragment (22, 24).

FIGS. 4A-4C and 9A-9B depict exemplary modular pegs (80) in accordancewith the present invention. Modular peg (80) has a top portion (or firstportion) (82) and a bottom portion (or second portion) (84). Top portion(82) and bottom portion (84) may be rotatably connected. Top portion(82) and bottom portion (84) may be snapped together, screwed together,swaged, joined together with a ball bearing or with a pin and caliper,or by other means.

As noted above, top portion (82) may include screw threads (86) capableof mating with screw threads on the inner surface of a bore inorthopedic plate (30). Threads (86) may extend from at or near the topend of top portion (82) along the outer surface of top portions (82) fora distance equal to or approximately equal to the thickness oforthopedic plate (30) or the length of the bore into which it is to beinserted. Threads (86) or a second thread (not shown) may extendpartially or fully along the remaining outer surface of top portion (82)and may engage a bone or bone fragment (22, 24) when modular peg isimplanted. The threads partially or fully along the remaining outersurface of top portion (82) may have a smaller outer diameter than thethreads at the top end of top portion (82), to facilitate inserting peg(80) through a bore in orthopedic plate (30).

Bottom portion (84) of modular peg (80) may have screw threads (notshown) extending along part of or along the entirety of its outersurface. The screw threads may engage the bone or bone fragment (22,24). The screw threads may be self-tapping threads. The bottom end ofmodular peg (80) may be tapered to further facilitate screwing modularpeg (80) into bone fragment (22, 24). The taper may also be threaded,and the threads may be self-tapping.

The top end of top portion (82) may include aperture (92) that iscapable of receiving a tool (not shown) to facilitate mating screwthreads (86) of top portion (82) with screw thread in a bore oforthopedic plate (30), or to facilitate screwing modular peg (80) intobone or bone fragment (22, 24). Aperture (92) may have a star shape, atriangular shape, a hexagonal shape, or any other shape to which thetool may be applied. The tool may have the same or similar shape as theshape of aperture (92).

Top portion (82) and bottom portion (84) may each include one or moreapertures (88). Aperture (88) may be tapered. A transverse bore mayextend transversely from each aperture (88) partially or completelythrough modular peg (80). Each transverse bore may be fully threadedwith screw threads (90), may have no threads, or may be threaded for aportion of the length of the bore and have no threads for the remainderof the length of the bore. The center axis of each transverse bore mayintersect the longitudinal axis of modular peg (80) at a perpendicularangle or at an angle offset from a perpendicular angle.

A key member (94) of bottom portion (84) may extend above the site wherethe bottom end of the bottom portion (84) and the top portion (82) meet,and into top portion (82). As shown in FIG. 4B, an aperture (97) at thetop of key member (94) may have a particular shape meant to receive akey insert of a targeting guide. The shape of aperture (97) may be adiamond, a square, an oval, an elongated circle, a star, or any othershape. In addition or in the alternative, as shown in FIGS. 9A and 9B,aperture (97) of key member (94) may lead to a cavity within key member(94). At the bottom of the cavity may be indentation (99). Indentation(99) may have the same shape as aperture (97) or may have a differentshape. For example, the shape of indentation (99) may be a diamond, asquare, an oval, an elongated circle, a star, or any other shape.Indentation (99) may be the same size as aperture (97), or as shown inFIGS. 9A and 9B, indentation (99) may have a smaller size than aperture(97). In addition or in the alternative, the exterior wall or walls ofkey member (94) may form the shape of a diamond, a square, an oval, anelongated circle, or a star.

One or more of the points or other shape features of key member (94),aperture (97), and/or indentation (99) may align with aperture (88)and/or the center axis of a transverse bore through bottom portion (84).In addition, or in the alternative, key member (94) may include one ormore markings indicating the orientation of aperture (88) and/or thecenter axis of a transverse bore through bottom portion (84).

As depicted in FIGS. 5, 7A-7C, and 10A, a compression screw (150) may beinserted through one bone or bone fragment (22), into a second bone orbone fragment (24), and join with a peg or modular peg (80). FIG. 6depicts an exemplary compression screw (150) that may have a first end(152) and a second end (154). Second end (154) may have a screw head(156). Screw head (156) may be tapered, bulbous, semispherical,cylindrical, or another shape. The exterior surface of screw head (156)may be threaded. In the alternative, compression screw (150) may nothave a screw head (156).

A shaft (160) may run from the bottom end (158) of screw head (156) tothe first end (152) of compression screw (150). If compression screw(150) does not have a screw head, then the shaft (160) may run fromfirst end (152) to second end (154). Some or all of shaft (160) may bethreaded with screw threads (162). First end (152) of compression screw(150) may be truncated and/or may have a self-tapping screw thread(164). Compression screw (150) may be cannulated to receive, forexample, a K-wire.

As shown in FIGS. 8-10 , a targeting guide (300) may be used to implantcompression screw (150). Targeting guide (300) may have a key insert(310) at a first end (320) and a screw guide (340) at a second end(330). First end (320) and second end (330) of targeting guide (300) maybe connected by bridge (350).

As shown in FIGS. 8B, 9A and 9B, key insert (310) of targeting guide(300) may be inserted into aperture (92) of modular peg (80). Key insert(310) may have the same shape and may be inserted into aperture (97)and/or indentation (99) of modular peg (80). Inserting key insert (310)of targeting guide (300) into indentation (99) may cause thelongitudinal axis of screw guide (340) to align with aperture (88) ofthe bottom portion (84) of modular peg (80). In the alternative, keyinsert (310) may have an aperture that fits over key member (94).Attaching key insert (310) of targeting guide (300) over key member (94)cause the longitudinal axis of screw guide (340) to align with aperture(88) of the bottom portion (84) of modular peg (80).

Also, as shown in FIG. 10B, rotating targeting guide (300) about thecenter axis of modular peg (80) may allow the compression screw to beimplanted at various angles in relation to orthopedic plate (30) and/orthe joint between the bone or bone fragments to be compressed. As shownin FIG. 10B, if key insert (310) is matched to and engages with aperture(97) and/or indentation (99), rotating targeting guide (300) by acertain angle (360) in one direction may cause bottom portion (84) ofmodular peg (80) to rotate the same angle (360) in the same direction,thereby maintaining the alignment of screw guide (340) with aperture(88) and the center axis of the transverse bore through bottom portion(84) of modular peg (80). Maintaining alignment of screw guide (340)with aperture (88) ensures that first end (152) of compression screw(150) will pass through aperture (88) when compression screw (150) isimplanted. Having the capacity to vary the angle at which compressionscrew (150) may be implanted allows the optimal angle to be chosen forbone fixation.

A drill guide (not shown) may be added to the screw guide to facilitatedrilling a hole for a compression screw. A wire guide may be added tothe screw guide or to the drill guide to facilitate insertion of aguidewire. The compression screw may be cannulated and may be implantedusing the guidewire.

If a plurality of pegs or modular pegs (80) are used with orthopedicplate (30), the distance between bottom surface (34) of orthopedic plate(300) and the center axis of each aperture (88) may be varied for eachmodular peg (80) to vary the height at which each compression screw(150) is implanted so that they do not make contact with each other.Preferably, to use the same targeting guide (300) to install eachcompression screw (150), as the distance between the center axis of eachaperture (88) and the bottom surface of plate (30) varies, the depth ofindentation (99) and/or the height of key member (94) may also vary bythe same distance to ensure that the screw guide (340) aligns eachcompression screw (150) with each aperture (88).

FIG. 11 depicts a method of implanting an assembly comprising anorthopedic plate, bone screws, a modular peg, and a compression screw.At Step 505, the bone or bone fragments to be joined are aligned andprepared. At Step 510, an orthopedic plate is provisionally pinned tothe joint or site where the bone or bone fragments meet. The pins may beinserted through one or more apertures intended for bone screws or insmaller apertures in the orthopedic plate. At Step 515, one or more bonescrews are implanted into the proximal bone or distal bone. As explainedabove, at this step, the one or more bone screws may instead beimplanted into a distal bone or bone fragment. At Step 520, a hole for amodular peg is drilled in one of the bone or bone fragments. The drillbit may pass through the aperture that will ultimately receive themodular peg. At Step 525, the modular peg is implanted. The top portionof the modular peg may be rotated so that threads on the outer surfaceof the top portion engage threads within the bore leading from theaperture.

At Step 530, a targeting guide may be attached to the modular peg. Forexample, as described above, a key insert of the targeting guide may beinserted into an aperture at the top end of the modular peg and mayengage a key member of the bottom portion of the modular peg and/or anindentation having the same shape as the key insert. When the targetingguide is coupled to the modular peg, a screw guide of the targetingguide may be aligned with a transverse bore in the modular peg. Thetargeting guide may be rotated until the transverse bore is angled in adesired direction to receive a compression screw. At Step 535, a holemay be drilled to a positive stop using a drill guide. A depth gauge maybe used to measure the desired length of the compression screw. At Step540, a guidewire such as K-wire may be inserted through the drilled holeand through the transverse bore in the modular peg. A wire guide may bejoined to the drill guide to facilitate insertion of the guidewire.

At Step 545, a compression screw may be implanted through one or both ofthe bones or bone fragments and through a transverse bore of the modularpeg. At Step 550, one or more bone screws may be implanted in a distalbone or bone fragment. As explained above, at this step, the one or morebone screws may instead be implanted into a proximal bone or bonefragment. At Step 555, the compression screw may be rotated. As thecompression screw is rotated, threads on the shaft of the compressionsscrew may engage threads in the transverse bore of the modular peg,drawing the head of the compression screw toward the modular peg andthereby compressing the bone or bone fragments.

The modular peg and compression screw in accordance with the presentinvention may also be used to join bones or bone fragments without anorthopedic plate. FIGS. 12A and 12B depict side and top views,respectively, of an assembly of a modular peg (680) and a compressionscrew (650) in accordance with the present invention. Threads (630) onthe exterior surface of top portion (640) of modular peg (680) may beused to implant modular peg (680). Otherwise, the same description formodular peg (80), compression screw (150), and targeting guide (300)would apply to the embodiments shown in FIGS. 12A and 12B. FIG. 13depicts modular peg (680) and compression screw (650) implanted in afoot to repair an avulsion fracture.

As shown in FIGS. 14-17 , a staple (420) may be used with the orthopedicplate (30) in accordance with the present invention. Orthopedic plate(30) may have an indentation (100, 400) capable of receiving a staple(420). Indentation (100, 400) may be aligned with and/or parallel to thelongitudinal axis of orthopedic plate (30) or may be offset at an anglefrom the longitudinal axis.

Staple (420) may have two arms (430). In a resting state, arms (430) maybend toward each other. Before inserting the staple (420) into the bonesor bone fragments, arms (430) may be spread apart so that they are, forexample, parallel to each other. While the arms (430) are spread apart,they may be inserted into the bones or bone fragment. As shown in FIG.16 , the inclination of the arms (430) to return to their resting statein which they are bent toward each other results in compression of thebone or bone fragments. As indicated in FIG. 17 , when compression screw(150) is implanted, it may pass between arms (430) of staple (420).

While the invention has been described with reference to the preferredembodiment and alternative embodiments, which embodiments have been setforth in considerable detail for the purposes of making a completedisclosure of the invention, such embodiments are merely exemplary andare not intended to be limiting or represent an exhaustive enumerationof all aspects of the invention. The scope of the invention, therefore,shall be defined solely by the following claims. Further, it will beapparent to those of skill in the art that numerous changes may be madein such details without departing from the spirit and the principles ofthe invention. It should be appreciated that the invention is capable ofbeing embodied in other forms without departing from its essentialcharacteristics.

What is claimed is:
 1. A system capable of fixating bones or bonefragments comprising: an orthopedic plate having a top surface and abottom surface and a first bore extending from an aperture at the topsurface to an aperture at the bottom surface; a peg extending along afirst longitudinal axis from a first end to a second end and comprisinga first portion rotatably connected to a second portion, wherein thefirst portion is configured to mate with the first bore, wherein thesecond portion comprises a transverse bore extending along a bore axistransverse to the first longitudinal axis; a compression screw extendingfrom a first end to a second end, said compression screw comprising ashaft having an outer surface, wherein the outer surface comprises screwthreads; and a targeting guide extending from a first end to a secondend, wherein the first end comprises a key insert and the second endcomprises a screw guide; wherein said second portion of the peg furthercomprises a key member having a shape feature aligned with the boreaxis, and wherein the key member is configured to receive the key insertof the targeting guide.